Kara Margolis, MD: Link Between Maternal SSRI Exposure, Increased Constipation Risk in Infants

A study presented at the 2024 Annual North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Meeting in Hollywood, Florida, from November 7 to 9, 2024, showed maternal SSRI exposure significantly increased the child’s risk for a functional constipation diagnosis. The findings also suggested that untreated maternal depression was associated with different diagnoses of gut-brain interaction, such as colic, than SSRI-treated maternal depression.

At the meeting, HCPLive spoke to investigator Kara Margolis, MD, from New York University, who talked about why her team conducted this longitudinal birth cohort study that examined the association between maternal depression with and without prenatal SSRI exposures and the risk of gut-brain interaction during infancy and early childhood. Although it is known maternal depression is linked to gut-brain interaction, the mechanistic links are not understood.

Knowing that SSRIs pass through the placebo and breast milk, Margolis’ team wanted to see if they increased the risk of developing gut-brain interactions.

“The key lesson [here] would be you not only have to consider the condition but also the medications that people are receiving,” Margolis said.

The study included 317 mother-child dyads who were recruited into 3 cohorts: with maternal depression and SSRI, maternal depression and no SSRI, and no maternal depression nor SSRI. Dyads were followed from the first trimester of pregnancy to 24 months of age.

Prenatal SSRI exposure was linked to a significantly increased risk for functional constipation in children, compared with mothers who had maternal depression but took no SSRIs (63% vs 31%; P = .001). Furthermore, colic was more prevalent in children aged 1 – 3 months whose mothers with maternal depression took SSRIs versus those who did not (13% vs 1.6; P = .048). Additionally, colic had a greater prevalence in the children of mothers with maternal depression who took SSRIs compared with mothers without maternal depression (7.2%).

HCPLive also spoke to Margolis, MD about how maternal depression with or without SSRI exposure correlated with the development of disorders of gut-brain interaction in infants and the link between maternal SSRI exposure and the increased risk of functional constipation in infants.

“What we saw was quite interesting,” Margolis said. “We saw that when children were exposed in utero to SSRIs, specifically, they tended to have a higher or significantly higher degree of functional constipation diagnoses. But in contrast, when we looked at those children who were exposed to maternal depression during pregnancy, but those mothers who were not treated with an SS or SNRI, those children had a significantly higher risk of being diagnosed with colic. The question becomes, mechanistically, are there differences in how maternal depression affects outcomes in terms of disorders of gut-brain interaction, and does that differ whether or not that mother is treated with an SS or SNRI?”

References

^{Bouchard, V, Gillet, V, Hua, J. Maternal Depression +/- In Utero Ssri Exposures Differentially Increase The Diagnostic Risk Of Disorders Of Gut-Brain Interaction (Dgbi): Seminal Data From The Prospective Birth Cohort Study “Development Of Functional Gastrointestinal Disorders (Getgas)”. Presented at NASPHGAN 2024 in Hollywood, Florida, from November 7 – November 9, 2024.}